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Abstract
Background: This study aimed to assess the risk factors and impact of acute myocardial infarction on in-hospital treatments, complications, outcomes, and resource utilization in hospitalized patients for heat stroke in the United States. Methods: Hospitalized patients with a principal diagnosis of heat stroke were identified in the National Inpatient Sample dataset from the years 2003 to 2014. Acute myocardial infarction was identified using the hospital International Classification of Diseases, Ninth Revision (ICD-9), diagnosis of 410.xx. Clinical characteristics, in-hospital treatment, complications, outcomes, and resource utilization between patients with and without acute myocardial infarction were compared. Results: A total of 3372 heat stroke patients were included in the analysis. Of these, acute myocardial infarction occurred in 225 (7%) admissions. Acute myocardial infarction occurred more commonly in obese female patients with a history of chronic kidney disease, but less often in male patients aged <20 years with a history of hypothyroidism. The need for mechanical ventilation, blood transfusion, and renal replacement therapy were higher in patients with acute myocardial infarction. Acute myocardial infarction was associated with rhabdomyolysis, metabolic acidosis, sepsis, gastrointestinal bleeding, ventricular arrhythmia or cardiac arrest, renal failure, respiratory failure, circulatory failure, liver failure, neurological failure, and hematologic failure. Patients with acute myocardial infarction had 5.2-times greater odds of in-hospital mortality than those without myocardial infarction. The length of hospital stay and hospitalization cost were also higher when an acute myocardial infarction occurred while hospitalized. Conclusion: Acute myocardial infarction was associated with worse outcomes and higher economic burden among patients hospitalized for heat stroke. Obesity and chronic kidney disease were associated with increased risk of acute myocardial infarction, while young male patients and hypothyroidism were associated with decreased risk.
Highlights
Heat stroke is a hazardous and potentially life-threatening form of heat-related illness characterized by the presence of an increasing core body temperature higher than 40.5 ◦C [1,2,3]
This large cohort study of 3372 patients found that acute myocardial infarction occurred in 7% of patients hospitalized for heat stroke
We identified that obesity and chronic kidney disease were independently associated with increased risk of in-hospital acute myocardial infarction, while age
Summary
Heat stroke is a hazardous and potentially life-threatening form of heat-related illness characterized by the presence of an increasing core body temperature higher than 40.5 ◦C [1,2,3]. Under normal conditions, when patients are exposed to a hot environment, the cardiovascular system enhances cardiac output, aiming to increase blood flow to the skin for cooling [11] This defense mechanism increases the oxygen consumption of the heart and might potentially precipitate a myocardial infarction. A previous study demonstrated that higher environmental temperatures are associated with an increase in the risk of myocardial infarction [12]. This effect is only influential during the first six hours after exposure [12]. Conclusion: Acute myocardial infarction was associated with worse outcomes and higher economic burden among patients hospitalized for heat stroke. Obesity and chronic kidney disease were associated with increased risk of acute myocardial infarction, while young male patients and hypothyroidism were associated with decreased risk
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